BILL ANALYSIS
AB 6 X4
Page 1
(Without Reference to File)
CONCURRENCE IN SENATE AMENDMENTS
AB 6 X4 (Evans)
As Amended July 23, 2009
2/3 vote. Urgency
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|ASSEMBLY: | |(July 9, 2009) |SENATE: | |(July 23, |
| | | | | |2009) |
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(vote not relevant) (vote not available)
Original Committee Reference: RLS.
SUMMARY: Contains statutory changes to the Medi-Cal program,
within the Department of Health Care Services (DHCS), in order
to achieve long-term savings and efficiencies and to implement
the 2009 Budget Act.
The Senate amendments delete the Assembly version of this bill,
and instead:
1)Health Care Coordination, Improvement, and Long-Term Cost
Containment Waiver or Demonstration Project.
Waiver
a) Require the Department of Health Care Services (DHCS) to
submit a Medi-Cal Waiver or Demonstration Project to the
federal government in order to achieve the following: i)
strengthen California's health care safety net, including
disproportionate share hospitals; ii) reduce the number of
uninsured Californians; iii) increase federal financial
participation; iv) improve health care quality and
outcomes; and, v) promote home and community based care.
b) Require the waiver to include Medi-Cal restructuring
proposals in order for the program to better serve the most
vulnerable beneficiaries, including seniors, people with
disabilities, children with significant medical needs, and
people with behavioral health conditions. The goals of
restructuring care for these populations include: increase
access to better coordinated and integrated care for these
populations, improve health outcomes, and slow long-term
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growth of the Medi-Cal program. Restructuring will also
seek to improve coordination between Medicare and Medi-Cal,
improve integration of physical and behavioral health care,
and use medical homes and specialty centers for children
with significant medical needs.
c) Require DHCS to submit the waiver to the federal Centers
for Medicare and Medicaid Services by a date that allows
sufficient time for the waiver to be approved by no later
than the later of either September 1, 2010, or the
conclusion of the current Medi-Cal Hospital (1115) waiver.
d) Authorize this waiver to seek authority to enroll
beneficiaries into specified organized delivery systems,
such as managed care, enhanced primary care case
management, or a medical home model.
e) Require the waiver to include processes, and criteria,
by which DHCS will evaluate and grant exemptions, on an
individual basis, from any mandatory enrollment of
beneficiaries into managed care.
f) Authorize DHCS to implement the wavier by way of
all-county welfare director letters, and not issue
regulations. Requires DHCS to notify and consult with
stakeholders prior to issuing such letters.
Stakeholder process
a) Require DHCS to convene and consult with a stakeholder
advisory group in developing the waiver and the
implementation plan. Requires the stakeholder group to
remain in place to advise on the continued operation of the
waiver; and,
b) Require the stakeholder group to include, but not be
limited to: persons with disabilities, seniors, legal
services agencies, specialty care providers, physicians,
hospitals, county government, and labor.
Implementation plan
a) Require DHCS to develop an implementation plan in
consultation with a stakeholder advisory committee; and,
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b) Require the plan to address the multiple and complex
needs of vulnerable populations, and the specific
strategies to be used to ensure the provision of quality,
accessible health care services under the waiver. The plan
shall include performance standards including: plan
readiness, accessible services, care coordination,
processes for beneficiary grievances and participation,
cultural and linguistic appropriateness, and others.
Notifications to, and Appropriation by, the Legislature
a) Require DHCS to regularly consult with the Legislature
on the development of the waiver;
b) Subject to federal approval of the waiver, authorizes
DHCS to enroll beneficiaries in organized delivery systems
but only after funds for this purpose have been
appropriated by the Legislature;
c) Require DHCS to submit an implementation plan to
legislative policy and fiscal committees, prior to
implementation of this waiver, and at least 60 days prior
to an appropriation by the Legislature for this purpose;
and,
d) Authorize DHCS to utilize state plan amendments to
accomplish the purposes described here, and requires the
director of DHCS to notify the Joint Legislative Budget
Committee of such actions.
1)Federal Claiming.
a) Establish the Legislature's intent that DHCS maximize
receipt of federal funds for the Medi-Cal program through
its existing demonstration project; and,
b) Authorize DHCS to maximize federal claiming by claiming
federal reimbursement for: i) expenditures in programs
funded by realignment funds including, but not limited to,
the County Medical Services Program; ii) expenditures in
programs funded by the County Mental Health Services Act;
iii) other public expenditures; and, iv) state-only funded
programs.
3)Fiscal emergency. Address the fiscal emergency declared by
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the Governor by proclamation on July 1, 2009.
4)Urgency Clause: Declare this bill take effect immediately as
an urgency statute.
AS PASSED BY THE ASSEMBLY , this bill was a vehicle for the
budget trailer bill.
Analysis Prepared by : Andrea Margolis / BUDGET / (916)
319-2099
FN: 0002078